Download - Context, change, and a longer view
![Page 1: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/1.jpg)
Context, change, and a longer view
Robert M. Pestronk
Executive Director
National Association of County and City Health Officials
2014 North Carolina State Health Director’s Conference
January 23, 2014
![Page 2: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/2.jpg)
•
![Page 3: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/3.jpg)
Once…
![Page 4: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/4.jpg)
Then…
![Page 5: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/5.jpg)
Forces for Convergence
Jackson Pollack, “Convergence”, 1952
![Page 6: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/6.jpg)
Perspective is important
![Page 7: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/7.jpg)
Local health department directors and departments
![Page 8: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/8.jpg)
Personal experience
Five Navigating relationships
![Page 9: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/9.jpg)
Striking a balance
• the three challenges underlying local health department practice…
![Page 10: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/10.jpg)
The first challenge
New Yorker magazine, 2012
![Page 11: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/11.jpg)
The second challenge…
Assessment Policy development Assurance
![Page 12: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/12.jpg)
The third challenge…
Relationships (constituency and politics)
Science
and/or
![Page 13: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/13.jpg)
The national context: state health departments
Accessed 1/19/14, http://www.50states.com/us.htm#.UtwYd2co6P8
![Page 14: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/14.jpg)
North Carolina within the national context
Accessed 1/19/14, http://geology.com/county-map/north-carolina.shtml
![Page 15: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/15.jpg)
Percentage of LHDs that are Part of a Health and Human Services Agency for all LHDs and North Carolina, by Size of Population Served , and Type of Governance
All LHDs North Carolina LHDsLHD is part of HHSA 20% 12%
Size of Population Served <25,000 15% 9%
25,000—49,999 19% 13%
50,000—99,999 25% 5%
100,000—499,999 25% 11%
500,000+ 26% 100%
Type of GovernanceState 42% --
Local 12% 12%
Shared 30% --n=1,966 n=78
Source: 2013 National Profile of Local Health Departments
![Page 16: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/16.jpg)
Percentage of LHDs where the Organizational Structure Changed within the Past Two Years for All LHDs and North Carolina, by Size of Population Served and Type of Governance
All LHDs North Carolina LHDsLHD Changed Structure
11% 12%
Size of Population Served <25,000 7% 9%
25,000—49,999 12% 13%
50,000—99,999 11% 9%
100,000—499,999 16% 15%
500,000+ 20% 0%
Type of GovernanceState 9% --
Local 10% 12%
Shared 19% --n=1,967 n=78
Source: 2013 National Profile of Local Health Departments
![Page 17: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/17.jpg)
Percentage of LHDs with a Local Board of Health for All LHDs and North Carolina, 2010 and 2013
All LHDs North Carolina LHDs2010 2013 2010 2013
LHDs has LBOH 75% 70% 100% 87%
Size of Population Served <25,000 76% 69% 100% 100%
25,000—49,999 84% 78% 100% 81%
50,000—99,999 79% 76% 100% 91%
100,000—499,999 67% 65% 100% 85%
500,000+ 54% 50% 100% 50%
Type of GovernanceState 43% 46% -- --
Local 86% 79% 100% 87%
Shared 54% 52% -- --n=2,099 n=1,974 n=79 n=78
Source: 2010 and 2013 National Profile of Local Health Departments
![Page 18: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/18.jpg)
Percentage of LHDs that are Local Governed with Select Local Board of Health Functions for ALL LHDs and North Carolina, 2010 and 2013*
LBOH Function All LHDs North Carolina
LHDs2010 2013 2010 2013
Advise LHD or elected officials on policies, programs, and budgets 87% 86% 94% 97%
Set policies, goals, and priorities that guide the LHD 81% 79% 95% 99%
Adopt public health regulations 79% 76% 97% 97%
Approve the LHD budget 74% 75% 77% 82%
Set and impose fees 73% 71% 77% 82%
Hire or fire agency head 65% 65% 96% 96%
Request a public health levy 39% 37% 11% 10%
Impose taxes for public health 18% 19% 0% 3%
n=1,565 n=1,371 n=79 n=67*Among LHDs with a Local Board of Health
Source: 2010 and 2013 National Profile of Local Health Department
![Page 19: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/19.jpg)
Teutsch, IOM Roundtable on Population Health Improvement, 2013
Making use of what we know
and water
(climate, earth, air, water)
• Preparedness
![Page 20: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/20.jpg)
The panel:
Gibbie HarrisDirectorBuncombe County Health Department
David StanleyDirector Brunswick County Health Department
Carolyn MoserDirectorPender County Health Department
![Page 21: Context, change, and a longer view](https://reader034.vdocuments.net/reader034/viewer/2022042822/56815fd9550346895dcedcce/html5/thumbnails/21.jpg)